Examination of the hip

Look

With the patient standing, assess for muscle wasting (gluteal muscle bulk in particular).

With the patient lying flat and face up, observe the legs, comparing one side with the other – is there an obvious flexion deformity of the hip?

If there is a suggestion of leg length disparity, assess true leg lengths using a tape measure. Measurements are taken from the anterior superior iliac crest to the medial malleolus of the ankle on the same side. Compare the measurements. In a fractured neck of femur the leg is shortened and
externally rotated.

Check for scars overlying the hip.

Feel

Palpate over the greater trochanter for tenderness.

Move

With the knee flexed at 90º, assess full hip flexion, comparing one side with the other and watching the patient’s face for signs of pain.

Assess for a fixed flexion deformity of the hip by performing Thomas’ test. Keep one hand under the patient’s back to ensure that normal lumbar lordosis is removed. Fully flex one hip and observe the opposite leg (see Figure 13). If it lifts off the couch then there is a fixed flexion deformity in that hip. (As the pelvis is forced to tilt a normal hip would extend allowing the leg to remain on the couch.)

With the hip and knee flexed at 90º, assess internal and external rotation of both hips. This is often limited in hip disease.

Assess the hip and proximal (gluteal) muscle strength by performing the Trendelenberg test. This involves the patient alternately standing on each leg alone. In a negative test the pelvis remains level or even rises. In an abnormal test the pelvis will dip on the contralateral side. (See Figure 14.)

Function

Ask the patient to walk – look for an antalgic or Trendelenberg gait. An antalgic gait simply means a painful gait, normally resulting in a limp. A Trendelenberg gait results from proximal muscle weakness and commonly results in a ‘waddling’ walk.

For more information, go to www.arthritisresearchuk.org.Arthritis Research UK fund research into the cause, treatment and cure of arthritis. You can support Arthritis Research UK by volunteering, donating or visiting our shops.